RN Case Manager: Care Coordination & Outcomes

Excellus BCBS; City of Utica (NY); Hybrid; USD 62,000 - 96,000; Full time

Job summary

Excellus BCBS is seeking a Case Management professional to conduct program activities in alignment with CMSA, NCQA, NYS DOH, and CMS standards. The role involves identifying eligible members, educating and coordinating care, and reviewing treatment options through collaboration with physicians and community resources.

You will participate in a cross-functional team to create comprehensive care plans, assess needs, and implement member-centric interventions to improve health outcomes while

Qualifications

• Proficiency with Microsoft Office Suite (Word, Excel, Outlook)
• Strong written and verbal communication skills
• Ability to multitask and manage priorities across cases
• Experience collaborating with cross-functional care teams and providers

Responsibilities

• Conducts case management activities per CMSA, NCQA, NYS DOH and CMS regulations.
• Identify members for case management, assess education and care coordination needs.
• Develop and implement comprehensive care plans with the interdisciplinary team.
• Coordinate services, review treatment options, and monitor outcomes with providers.
• Maintain confidentiality and ensure compliance with privacy policies.
• Lead or participate in ongoing staff education and process improvement initiatives.
• Collaborate with internal stakeholders to support value-based programs such as ACQA.
• Provide timely case openings, reviews, and documentation updates as required.

Skills

Microsoft Office

Communication skills

Multitasking

Interdisciplinary collaboration

Education

Associates degree

Bachelor’s degree preferred

Job description

Excellus BCBS is seeking a Case Management professional to conduct program activities in alignment with CMSA, NCQA, NYS DOH, and CMS standards. The role involves identifying eligible members, educating and coordinating care, and reviewing treatment options through collaboration with physicians and community resources.

You will participate in a cross-functional team to create comprehensive care plans, assess needs, and implement member-centric interventions to improve health outcomes while